Zalma on Insurance
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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail

Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.

My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance claims, the basic insurance policies used by the insurer, and assigned to handle minor insurance claims. I had no difficulty with the reading since I was a college graduate and had simultaneously enrolled in a night law school.

After I had learned the basics from the reading and assistance of an experienced claims supervisor I was sent to ride along with experienced adjusters in every type of insurance sold by my employer. I rode, and learned from, a surety adjuster, a workers’ compensation adjuster, first party property adjusters and third party liability adjusters. I was then sent to the insurer’s home office for a full month of classroom training on everything from the effect of traumatic injuries, reconstruction of fire, wind, or water damaged structures, tort law, contract law, and insurance policy interpretation.

After completing the classroom training I was allowed to deal with small claims by telephone under the very close supervision of an experienced claims supervisor and the claims manager.

Eventually I convinced my supervisor that I knew the basics of the insurance claims business, how to investigate a claim, how to interview an insured and independent witnesses and how to evaluate a claim. I was assigned a company car, a Nash Ambassador, and claims to handle in person from small water damages, kitchen fires, and other small claims until my abilities improved and I was able to handle a major claim with the assistance of the manager, supervisor and experienced staff adjusters and consultants. I was also able to apply to my claims work with what I was learning in law school.

It took me more than a year of intensive training and education to be classified as a field claims representative. I was, with the training and experience provided to me, a professional claims adjuster and worked as one until four years later when I passed the California Bar and became a licensed attorney.

Today, I’m much older, worked for five years as an adjuster, and 45 more years as an insurance defense lawyer and insurance coverage lawyer. I have, since 2015, worked as an insurance consultant and expert witness, a blogger, and an author on claims handling, insurance coverage and the tort of bad faith.

Becoming a Claims Expert Witness

After 45 years of practicing law a lawyer I knew asked me to be an expert in one of his cases. I had retained many experts in my legal career but this would be my first time testifying to a federal jury with a judge who would have preferred a different case. Although I was frightened on my first attempt I found I was good at explaining insurance and insurance claims handling to a judge and jury. My first attempt – whether because or in spite of my effort – resulted in a verdict in favor of the lawyer client.

In 2015 I was exhausted at operating a law firm and reduced the firm to just me and a computer. I changed my practice as an insurance consultant and expert the only thing I do. My license to practice law is inactive.

Claims experts are retained by lawyers who are litigating an insurance claim dispute after the litigation commences. I am retained by both insurance defense lawyers and policyholder’s lawyers. I have learned that the adjusters who dealt with claims when I did have either retired or died. I now see the work of inexperienced, minimally trained and often incompetent insurance adjusters because their work, or failure to work, were involved in situations that caused the insurer for whom they worked, get sued.

Today I spend most of my time reviewing claims files from counsel litigating insurance claims disputes, write this daily blog, write and update insurance claims books, and testify as an expert witness on behalf of counsel for policyholders and insurers.

Part 2 will deal with the Modern American Claims Adjuster.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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Videos
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September 18, 2026
Expert May Only Testify to What Experience Supports

Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.

Posted on September 18, 2026 by Barry Zalma

See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html

In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.

The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.

Law

The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

150 Months in Prison for Tax Fraud
Post 4846

Posted on September 17, 2026 by Barry Zalma

See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.

FACTS

In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS

Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.

The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution

Post 5489

Posted on September 14, 2026 by Barry Zalma

Fraudster Refuses to Answer Questions About His Alleged Fraud

See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr

In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.

Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.

After Great American ...

00:05:14
23 hours ago
Excess Insurers May Face Declaratory Relief and Bad Faith Claims Before Coverage Attaches

Is Exhaustion Required to Seek Declaratory Relief From an Excess Insurer?

Post 4578

Posted on November 9, 2026 by Barry Zalma

In Fox Paine & Company, LLC, et al. v. Twin City Fire Insurance Company et al., S287404, 593 P.3d 832, 593 P.3d 838, 346 Cal.Rptr.3d 541, Supreme Court of California, (July 27, 2026) the Supreme Court noted that Insurance is sometimes procured in a series of layers, with an insured acquiring a primary insurance policy that provides an initial layer of coverage for loss or liability and an excess insurance policy or policies that provide additional coverage in the event the underlying coverage is exhausted. Usually, the first layer of coverage must be exhausted before the excess layers are available to the insured.
Exhaustion

Fox and Paine’s investment-firm dispute generated extensive litigation and competing insurance claims. Their insurance tower consisted of a $10 million primary policy and four $10 million excess layers.

The Fox Parties alleged that insurers paid their rivals, withheld information,...

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November 05, 2026
Convicted of Felony Fraud You Lose the Right to Vote

Payment of Fines & Completion of Probation Reinstates Right to Vote

Post 4576

Posted on November 5, 2026 by Barry Zalma

To Restore Voting Rights The Felon Must Pay Fines of $546.00

In Florida Supreme Court Mediator Ethics Advisory Committee, ETH F-26-377, No. F-26-377 (October 29, 2026) citizen unnamed and to Ron Desantis Governor, Cord Byrd the Secretary of State Florida Division of Elections provided an advisory opinion to a convicted felon about his right to vote:

To: [redacted] We received your request for an advisory opinion. You indicate that you have one or more felony convictions and request whether you are eligible to vote, including whether you have any outstanding legal financial obligations under section 98.0751, Florida Statutes, and, if so, a statement of the amount that must be paid to make you eligible to vote, and an explanation of how the amount was calculated.

The Division hereby responds to your request pursuant to its legal authority under section 106.23(2), Florida Statutes, and Florida ...

November 04, 2026
Castro Valdez Had an Available Administrative Appeal and Failed to Establish a Ground for Excusing

Administrative Review Permits the Agency to Apply its Expertise

Post 4574

In Erwin Jordan Castro Valdez v. Warden, Otay Mesa Detention Center, No. 26-cv-06147-BAS-JLB, United States District Court, S.D. California (October 30, 2026) Castro Valdez, a Cuban national paroled into the United States, was arrested on June 23, 2026, for alleged insurance fraud, grand theft, and making a false report to law enforcement. In his first habeas action, the district court ordered a bond hearing within fourteen days to determine whether the changed circumstances justified revoking his parole.

An Immigration Judge subsequently denied bond because of his pending state criminal case. Castro Valdez filed a second petition under 28 U.S.C. § 2241, challenging that determination and requesting immediate release without first appealing to the Board of Immigration Appeals (BIA).

LAW

According to the supplied text, § 2241 does not expressly require administrative exhaustion, but courts impose exhaustion as a prudential requirement. ...

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